ABSTRACT
Seminomas are very radiosensitive. Therefore, stage 1 and 2 seminomas are usually treated with inguinal orchidectomy plus lymph node radiotherapy. More advanced seminomas are treated with inguinal orchidectomy plus BEP (bleomycin, etoposide, cisplatin) chemotherapy. Metastatic teratomas are usually treated with inguinal orchidectomy plus bleomycin, etoposide, cisplatin (BEP) chemotherapy. Tumour markers may be useful in assessing reponse to therapy. Alpha-fetoprotein (α-FP) and beta human-chorionic gonadotrophin (β-hCG) is raised in approximately 70 per cent of teratomas. β-hCG is elevated in 15 per cent of seminomas. This patient has been diagnosed with metastasis to the para-aortic lymph nodes. Therefore, postoperatively, the treatment that provides the highest chance of cure is chemotherapy (A). Lymph node dissection (B) is not performed as BEP chemotherapy gives the highest chance of cure. Radiotherapy (C) would be sensible for low stage seminomas. Chemoradiotherapy (D) is not performed in testicular cancer. Surveillance with tumour markers (E) is inappropriate as the disease is known to have spread.
